Improvements Needed In Genomic Test Result Discussions

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CHAPEL HILL, N.C. - One in three early stage breast cancer patients who received genomic testing when deciding about treatment options felt they did not fully understand their discussions with physicians about their test results and their risk of the disease recurring, a new study has found.

The research, conducted by University of North Carolina at Chapel Hill investigators, also revealed about one in four women experienced distress when receiving their test results.

Published online March 8, 2010, in Cancer, a peer-reviewed journal of the American Cancer Society, the findings suggest there is room for improvement in the way doctors communicate with patients about cancer recurrence risks and treatment decisions.

Genomic testing is an increasingly important part of care for patients after they are diagnosed with early stage breast cancer. Tests such as the Oncotype DX genomic diagnostic test, which looks at 21 genes in breast tumors that have been removed during surgery, can indicate the chance a woman’s cancer will return. Such information can help guide physicians and patients’ decisions about chemotherapy. Patients with a high risk of recurrence may opt for more aggressive treatment, while those with lower risk may safely avoid over-treatment and potential side effects.

However, it can be challenging for doctors to determine the best way to talk to patients about their test results and to use them to make treatment decisions together. Currently, there is little consensus regarding the most effective method of communicating risk information to patients.

Noel Brewer, Ph.D., assistant professor of health behavior and health education at the UNC Gillings School of Global Public Health, and Janice Tzeng, who worked on the new study as a graduate student at the school, led a team that examined how women with breast cancer received and understood cancer recurrence risk information after receiving the Oncotype DX test.

To find out more about women’s reactions, investigators mailed surveys to 77 women with early stage, estrogen receptor-positive breast cancer who received the test between 2004 and 2009. The study was funded by a five-year grant from the American Cancer Society.

“Almost all women agreed that having the test gave them a better understanding of their treatment options’ chances of success,” said Brewer, also a member of UNC’s Lineberger Comprehensive Cancer Center. “Most women said that they would have the test if they had to decide again today, and that they would recommend the test to other women in their same situation.”

Also, most women accurately recalled their recurrence risk results. The findings suggest that patients have a positive attitude about genomic testing, and testing helps them better understand their treatment options, he said.

While many women understood discussions about their test results, a third reported not fully understanding these discussions. Women who believed they understood less did not receive printed materials about the test.

Although 87 percent of women received a low or intermediate breast cancer recurrence risk score, about a quarter experienced distress when receiving their test results. Distress was more common among women who had intermediate or high recurrence risk scores (only 18 percent of women classified as having a low recurrence risk were distressed, compared to 30 percent with intermediate scores and 44 percent with high risk results). Stronger feelings of distress were also related to getting chemotherapy, not getting radiation, and worrying more frequently about breast cancer recurrence.

The authors concluded that their findings suggest a need to improve risk communication and treatment decision making after patients undergo genomic testing.

Other study co-authors were Deborah Mayer, PhD, UNC School of Nursing; Alice Richman, PhD, health behavior and health education department, and Carmina G. Valle, nutrition department, both in the UNC public health school; Isaac Lipkus, PhD, Duke University School of Nursing; Paul K. Han, MD, division of cancer control and population sciences, National Cancer Institute, Bethesda, Md.; and Lisa A. Carey, MD, medicine department, UNC School of Medicine and member of the Lineberger Center.